Healthcare Provider Details

I. General information

NPI: 1285872796
Provider Name (Legal Business Name): ERIKSON INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 N LASALLE ST
CHICAGO IL
60654-4510
US

IV. Provider business mailing address

451 N LASALLE ST
CHICAGO IL
60654-4510
US

V. Phone/Fax

Practice location:
  • Phone: 312-893-7194
  • Fax: 312-893-7229
Mailing address:
  • Phone: 312-892-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARGRET NICKELS
Title or Position: DIRECTOR/LICENSED CLINICAL PSYCHOLO
Credential: PH.D
Phone: 312-893-7194